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Practice Questions

Over 900 review questions covering over 15 disciplines. Here are some sample questions:

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Question 1 of 3

1. Question

The heart murmur of valvular aortic stenosis has which of the following characteristics?

A - Maximum intensity of the murmur is usually located along the lower left sternal border.

B - Maximum intensity is appreciated over the right second interspace.

C - Murmur radiates to the left axilla.

D - Murmur radiates to the back.

E - In standing position murmur increases in intensity.

Correct

In valvular aortic stenosis, the maximum intensity is appreciated over the right second interspace (a thrill may be palpable over the same area). This murmur radiates into the neck and over both carotid arteries. Atherosclerosis in elderly patients and congenital bicuspid valve are the most common causes of valvular aortic stenosis. Supravalvular stenosis has point of maximum intensity somewhat higher, and intensity of the radiating murmur may be more intense over the right carotid artery than over the left. In subvalvular left ventricular outflow obstruction (Hypertrophic cardiomyopathy) the maximum intensity of the murmur is usually located along lower left sternal border or over the cardiac apex. It radiates poorly to the base of the neck. Standing position increases intensity of the murmur of subvalvular left ventricular obstruction and decreases that of the valvular aortic stenosis.

Incorrect

In valvular aortic stenosis, the maximum intensity is appreciated over the right second interspace (a thrill may be palpable over the same area). This murmur radiates into the neck and over both carotid arteries. Atherosclerosis in elderly patients and congenital bicuspid valve are the most common causes of valvular aortic stenosis. Supravalvular stenosis has point of maximum intensity somewhat higher, and intensity of the radiating murmur may be more intense over the right carotid artery than over the left. In subvalvular left ventricular outflow obstruction (Hypertrophic cardiomyopathy) the maximum intensity of the murmur is usually located along lower left sternal border or over the cardiac apex. It radiates poorly to the base of the neck. Standing position increases intensity of the murmur of subvalvular left ventricular obstruction and decreases that of the valvular aortic stenosis.

Question 2 of 3

2. Question

All of the following are causes of aortic stenosis except:

A - Congenital

B - Syphilitic involvement of the aortic root

C - Idiopathic calcification of the aortic valve

D - Rheumatic inflammation of the aortic valve

E - Progressive stenosis of the congenital bicuspid valve

Correct

Congenital stenosis of the aorta, idiopathic calcification of aortic valve, Rheumatic inflammation of the valve, and progressive stenosis of the bicuspid valve are all established etiologic mechanisms of aortic stenosis. Syphilitic involvement of the aortic root usually results in the dilatation of the aortic root, resulting in aortic insufficiency and the development of an aneurysm of the ascending part of the aortic arch.

Incorrect

Congenital stenosis of the aorta, idiopathic calcification of aortic valve, Rheumatic inflammation of the valve, and progressive stenosis of the bicuspid valve are all established etiologic mechanisms of aortic stenosis. Syphilitic involvement of the aortic root usually results in the dilatation of the aortic root, resulting in aortic insufficiency and the development of an aneurysm of the ascending part of the aortic arch.

Question 3 of 3

3. Question

A 56-year-old male patient in the intensive care unit after a cardiac arrest was found to have hypokalemia (2.9 meq/l). He was treated with intravenous KCl administration of 80 meq over the next 4 hours. Repeated measurement of the potassium revealed a level of 3.2 meq/l. He was then given another 40 meq of KCl intravenously and started on 20 meq of KCl daily through a nasogastric tube. His next serum potassium measurement was 3.4 meq/l. After another 40 meq of KCl, the level was 3.5 meq/l. Which of the following is the most likely cause of his refractoriness to potassium replacement?

A - His total potassium deficit is much higher than the lab results suggest.

B - He is most likely has continuing potassium loss that is not apparent.

C - He has concomitant hypomagnesemia.

D - He has concomitant hypocalcemia.

E - He has concomitant hypernatremia.

Correct

Educational objective: Emphasize importance of hypomagnesemia for correction of hypokalemia.

The most common case for refractory hypokalemia is concomitant hypomagnesemia. Until this is corrected it may be difficult to correct hypokalemia and hypocalcemia. In all patients that have cardiac arrhythmias, coronary artery disease, and congestive heart disease it is necessary to have the magnesium level determined and kept over 2.0 meq/l at all times. This, along with potassium level over 4.0 meq/l, is prerequisite for successful therapy. Even if the potassium deficits in some patients may be in the range of 400-600 meq their serum potassium levels should reflect it (levels in the range of 2.0-2.4 meq/l) and respond with appropriate increase with replacement). In addition, potassium losses are relatively easy to detect, especially in the setting of an intensive care unit, where urine outputs, vomited material, and stools are carefully measured. Hyponatremia and hypocalcemia have no significant impact on efficacy of the potassium replacement.

Incorrect

Educational objective: Emphasize importance of hypomagnesemia for correction of hypokalemia.

The most common case for refractory hypokalemia is concomitant hypomagnesemia. Until this is corrected it may be difficult to correct hypokalemia and hypocalcemia. In all patients that have cardiac arrhythmias, coronary artery disease, and congestive heart disease it is necessary to have the magnesium level determined and kept over 2.0 meq/l at all times. This, along with potassium level over 4.0 meq/l, is prerequisite for successful therapy. Even if the potassium deficits in some patients may be in the range of 400-600 meq their serum potassium levels should reflect it (levels in the range of 2.0-2.4 meq/l) and respond with appropriate increase with replacement). In addition, potassium losses are relatively easy to detect, especially in the setting of an intensive care unit, where urine outputs, vomited material, and stools are carefully measured. Hyponatremia and hypocalcemia have no significant impact on efficacy of the potassium replacement.

MedCert Flashcards

Over 200 flashcards to test your memory of important topics.

From your mobile phone or tablet you can log on and review on the go MEDCERT ABIM-specific flashcards...

What is the difference between

Competence

and

Capacity?

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Capacity is a physician determination of a patient's ability to make decisions. Competence is a legal determination made only by the court system about a patients ability to make decisions on their own behalf.

Salmonella Diarrhea Treatment??

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Intestinal salmonellosis in an immunocompetent host

does not

require antimicrobials because they may prolong fecal shedding of organisms.

Nurse is accidentally stuck while drawing blood

from Hep C positive patient.

What next?

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After accidental needlestick exposure, neither immunoglobulin nor preemptive therapy is recommended. Patients should be monitored with HCV RNA and LFT testing at baseline, weeks 2 and 4, and then, 6 months after exposure.

Associated with???

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Erythema Multiforme are most commonly associated with:

Herpes simplex

Drug allergy (PCN, phenytoin, & sulfa drugs)

A cat bite most likely will get infected with?

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Pasteurella multocida

Treat with Amoxicillin /Clavulanate,

or Cipro + Clindamycin

for 3 - 5 days

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Chronic Lymphocytic Leukemia

Campylobacter Diarrhea Treatment?

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Erythromycin

or

Azithromycin (better tolerated)

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CMV Retinitis

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Iridis

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Barrett's Esophagus

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Reed Sternberg Cell

Hodgkin's Lymphoma

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Atrial Flutter

Smudge cell

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Chronic Lymphocytic Leukemia

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Heberden Node

Consistent with Osteoarthritis

Clinical Presentations

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